Geriatric High-Energy Traumas Doubled in 10 Years?!; Is Arthroscopic Partial Meniscectomy Useless?; Surface Topography Helps With Body Image in AIS

Geriatric High-Energy Traumas Doubled in 10 Years?!

Things aren’t looking so good for the elderly, says new work from the University of Alabama, Yale University, and the University of Arizona. The study, “Ten-Year Incidence of High-Energy Geriatric Trauma at a Level 1 Trauma Center,” appears in the March 18, 2018 edition of the Journal of Orthopaedic Trauma.

Jeffrey M. Pearson, M.D. is with the University of Alabama’s Department of Orthopaedic Surgery. Dr. Pearson, a co-author on the study, told OTW, “This topic interested us because of the sheer volume of trauma patients we were seeing at our institution. We felt we needed to report on the increase in volume we were seeing in this patient population. Our volume of patients based on our institution’s catchment area allowed us to give an accurate assessment of the trends we reported on in this study.”

The authors wrote, “Demographic, injury, and clinical characteristics were compared between 34,017 patients with geriatric and nongeriatric high-energy trauma from 2005 to 2014…Patients with geriatric high-energy trauma nearly doubled from the study period of 2005-2014 to previous 10 years. Compared with patients with nongeriatric trauma, geriatric high-energy traumas were twice as likely to be due to a fall from height, had higher Injury Severity Scores, fewer abdominal injuries, and have head trauma…”

Dr. Pearson told OTW, “High energy geriatric trauma is on the rise. We have shown that these patients have worse outcomes as well compared to their younger counterparts. It might be beneficial for institutions to start a protocol for high energy geriatric trauma similar to a protocol for fragility fractures. These patients are predisposed to poor outcomes and it is incumbent upon us to do as much as we can to limit their poor outcomes.”

“This is simply an epidemiologic study and more work needs to be done to better elucidate protocols to improve the outcome of these patients.”

Is Arthroscopic Partial Meniscectomy Useless?

“No benefit” says new research of arthroscopic partial meniscectomy (APM). The study, “Surgeon Practice Patterns of Arthroscopic Partial Meniscectomy for Degenerative Disease in the United States: A Measure of Low-Value Care,” was published in the February 28, 2018 edition of JAMA Surgery.

Co-author Martin A. Makary M.D., M.P.H. is professor of Surgery at Johns Hopkins School of Medicine and professor of Health Policy & Management at Johns Hopkins University School of Public Health in Baltimore, Maryland. Dr. Makary told OTW, “We found that despite studies showing that meniscectomy-only procedures have limited benefit in older patients with degenerative disease, it remains one of the most common procedures in this population. This may be driven in part by patient demand.”

“If patient safety was the focus of the last 20 years, the next 20 will be focused on appropriateness. While a meniscectomy procedure may be a high-value procedure in select patients, we found it’s prevalence in older patients with degenerative disease represents an area for improvement.”

“We used clinical consensus to define a metric of appropriateness on a practice pattern level. That is, what proportion of all your knee arthroscopies in older patients with degenerative disease, were a meniscectomy-only procedure (no repair performed). For some it’s a small percent, and for others it’s 90-100%.”

“There is wide variation in practice patterns around the procedure for older patients with degenerative disease. We also found a group of 500 high-volume arthroscopic knee surgeons in the U.S. who perform an isolated meniscectomy procedure as the only arthroscopic knee procedure they perform in a year.

“Our research team believes that confidentially informing outliers of their data, with the support of the specialty association, is the best first step to address extreme outliers. Quality improvement is best when it is home-grown by doctors and for doctors.”

“As a surgeon, I truly believe that most surgeons always try to do the right thing. However, we can do better as a profession in helping outliers, when there is broad clinical consensus around that outlier practice pattern.”

Surface Topography Helps With Body Image in AIS

To help alleviate the concerns of patients with adolescent idiopathic scoliosis (AIS) researchers from the Icahn School of Medicine at Mount Sinai in New York set out to see if body surface topography (ST) improvements are associated with surgical correction in AIS and correlate with health-related quality of life.

Baron Lonner, M.D. is professor of orthopaedics at Icahn, and was a co-author on the study. Asked if surface topography is widely used, Dr. Lonner told OTW, “It is not as the technology is not readily available and is expensive. Only a few centers in the country have access to the tool.

“We set out to investigate changes in boys’ shape after corrective surgery for adolescent idiopathic scoliosis. Self-image is the most impacted of all quality of life indicators in this patient population. X-rays fail to really show directly, what the patient sees in the mirror and what others see, namely body shape which is affected by the scoliosis. Surface topography does a good job of showing the body shape changes associated with scoliosis. We investigated those changes and their improvement following surgery.”

The authors wrote, “Twenty-three consecutive operative AIS patients were enrolled and had radiographs and posterior ST obtained pre- and post-operatively (PO). ST changes were compared using paired t-test and correlations of ST with x-ray measurements and SRS-22 scores were evaluated by linear regression and Pearson correlation.”

“…ST highly correlated with radiographic parameters. ST waist asymmetry correlated with satisfaction, self-image and PO total domains and improvement in pain scores. Sagittal balance correlated with improved function.”

Dr. Lonner commented to OTW, “The results were not surprising, but for the first time, we have shown in an objective way, the improvements in body shape after scoliosis surgery. This approach, the use of this technology, will provide us who treat scoliosis patients with information that can be used to council patients and their families about the improvements in their body shape that can be expected with surgery and use this to modify corrective strategies as needed to improve body shape and by extension, self-image of the patient. Over longer-term follow-up, we will show how these improvements correlate with quality of life indicators for the individual.”